Unc Medical Release Form. Web my written revocation to the medical information management department. Web to release the protected health information of the patient named above to:
Unc Medical Records Release Form
These forms can be found via the “ forms ” link on the intranet home page. Fill in your authorization form. Web my written revocation to the medical information management department. Click here for the spanish version. Web campus health release of information form. Web unc hospitals unc health information management attn: Relmedinfo@unch.unc.edu fax fax your completed authorization form to: The campus health medical release of information form is used for consent to sharing previous medical encounter details with campus health or transmit your campus health records. Web unc hospitals unc health information management attn: You can also view your personal health records on the healthy heels portal.
Click here for the english release form. Web unc hospitals unc health information management attn: University of north carolina at chapel hill. Fill in your authorization form. Web campus health release of information form. We cannot accept an electronic signature on release of information forms. Under federal medical privacy law. Unless otherwise revoked, this authorization will expire on the following date, event, or condition: Web to release the protected health information of the patient named above to: If you need your records released within 48 hours, a rush fee may be charged to release your records. Web authorization to release medical information authorize the named health care provider to release the information or records specified to north carolina league of municipalities upon request in person or by mail to the address specified at the time of the request.
